Application to Date My Daughter
NOTE: This application will be considered incomplete and rejected unless accompanied by a complete financial statement, job history, family lineage, and current medical report from your doctor.
— SECTION 1 : GENERAL INFORMATION —
- FULL NAME ___________________________________________________
- NICKNAMES ___________________________________________________
- “STREET” NAMES _________________________________________________
- Explain why you have these nicknames _____________________________________________________________________________________________________________________________________________________________________
- AGE ______ DATE OF BIRTH _________________
- Is your date of birth within 2 years of my daughter’s? ___Yes __ No
- HEIGHT ______________
- WEIGHT ______________
- IQ _____________ GPA _____________
- SOCIAL SECURITY # _________________
- DRIVERS LICENSE # _____________________
- SELECTIVE SERVICE #____________________
- Boy Scout rank and highest badges earned ____________________________________________
- HOME ADDRESS ___________________________
- CITY/STATE ______________ ZIP ___________
Do you have 2 parents? ___ Yes ___ No
Is one male and the other female? ___ Yes ___ No
If Not, explain:__________________________________________
Are your parents married? ____ Yes ___ No
Number of years they have been married _______
If less than your age, explain ______________________________________________
Where do you live?
- ___ with my parents
- ___ in a dorm room
- ___ with friends
- ___ have my own place
- ___ with my ex
- ___ wherever, dude
— SECTION 2: LIFESTYLE —
Do you own or have access to:
a van? ___ Yes ___ No
a truck with oversized tires? ___ Yes ___ No
a waterbed? ___ Yes ___ No
Do you have:
a tattoo? ___ Yes ___ No
an earring, nose ring or any other piercing? ___ Yes ___ No
(pierced tongue, pierced nipples or an ear gauge?)
Do you:
Use tobacco? ___ Yes ___ No
Smoke weed? ___ Yes ___ No
Drink alcohol? ___ Yes ___ No
Huff? ___ Yes ___ No
Take drugs? ___ Yes ___ No
Have sex regularly? ___ Yes ___ No
NOTE: IF YOU ANSWERED ‘YES’ TO ANY OF THE ABOVE QUESTIONS, YOU MAY DISCONTINUE YOUR APPLICATION AND LEAVE PREMISES QUICKLY AND IMMEDIATELY.
— SECTION 3: ESSAY questions —
Describe in 50 words or less, what ‘LATE’ means to you. ____________________________________________________________________________________________________________________________________________________
Describe in 50 words or less, what ‘DON’T TOUCH MY DAUGHTER’ means to you.
____________________________________________________________________________________________________________________________________________________
Describe in 50 words or less, what ‘ABSTINENCE’ means to you.
____________________________________________________________________________________________________________________________________________________
— SECTION 4: REFERENCES —
Church you attend ______________________________________________________
How often do you attend? ______________________________________________________
When would be the best time to meet your:
father? _____________
mother? _____________
doctor? _____________
Youth minister?____________
teachers?_______________
